Exergaming Platform Research Articles

Energy Expenditure Validation of an Exergame Platform: Ring Fit Adventure Use in Adults with Overweight and Obesity.

Objective: This study aims at comparing the energy expenditure (EE) and heart rate (HR) data from Ring Fit Adventure (RFA) with those from indirect calorimetry (COSMED) and a heart rate monitor (Polar FT7). A secondary goal is to evaluate self-reported enjoyment and perceived effort levels. Materials and Methods: Thirty participants (age = 21.8 ± 2.2; body mass index = 31.8 ± 4.4) were recruited for two laboratory visits. The first visit involved baseline measurements. In the second visit, participants performed a 55-minute ad libitum exercise session with the RFA in adventure mode with moderate difficulty. During this session, EE, HR, perceived effort, and enjoyment of physical activity were recorded. Results: Although no statistically significant overestimation of EE was found between the RFA and the metabolic cart, two-way analysis of variance results show a main effect of condition (RFA vs. Polar FT7) on HR (122.8 ± 20.1 bpm and 129.0 ± 18.6 bpm; P = 0.007; ᶯp2 = 0.235). Based on comprehensive statistical evaluations, including the mean absolute percent error, intraclass correlations, typical error of measurement, and limits of agreement, the data suggest that the RFA provides reliable estimates for EE and HR. Overall, participants enjoyed the game considerably (71.3 ± 5.9/80 arbitrary units), and their reported perceived exertion was low. Conclusion: This study underscores that the RFA values are relatively accurate and precise, and thus it can be safely suggested for individuals with overweight and obesity to adopt an active lifestyle.

Field-based fitness measures improve via an immersive virtual reality exergaming platform: a randomized controlled trial

While there has been a recent onslaught of traditional lab-based fitness measures in immersive virtual reality (IVR) exergaming research, there remains a paucity in the field-based fitness domain, which refers to assessments made outside a formal laboratory setting which are easier, cheaper, and have more practical application. This study aimed to assess changes in field-based fitness tests including the 1-mile run, 20-m dash, multiple single-leg hop-stabilization test, Abalakov jump, and 5-10-5 Pro Agility test during a 1-month workout protocol and to compare differences between groups assigned to either an IVR machine-directed exergaming platform or a traditional, self-directed cable-resistance training control (SELF). Eighteen (7 females) college-aged participants with little resistance training experience were randomized to IVR or SELF and worked out thrice weekly for 4 weeks (12 sessions). Wilcoxon rank-sum tests were performed for continuous variables to assess significance. Compared to SELF, the IVR group had significantly better performance improvements in 20 m dash (−0.1s vs. 0.0s, p = 0.022), 5-10-5 Pro Agility Test (−0.1s vs. −0.0s, p = 0.003), Abalakov Jump (5.8 cm vs. 2.0 cm, p = 0.0013), 1-Mile Run (−11.0s vs. −2.0s, p = 0.008), and Multiple Single-Leg Hop-Stabilization Test with their dominant (−9.0s vs. 1.0s, p = 0.0015) and non-dominant (−8.0s vs. 1.0s, p = 0.003) legs. This training study demonstrates that IVR exergaming, more so than those that traditionally resistance train (SELF), can improve many field-based fitness components including agility, balance and stability, speed/acceleration, cardiovascular endurance, and lower-body power.

Factors Associated with Intention of Sustainable Use in Players of the Wii Fit or Smartphone-Based Fitness Applications

The Wii Fit (Nintendo, Kyoto, Japan) is the most commonly used exergame platform for balance training. We explored diverse factors associated intention of sustainable use of either the Wii Fit or smartphone-based fitness applications. Then, we analyzed differences in such factors between users of the Wii Fit and those of smartphone-based fitness applications. We selected followers of the Instagram, Facebook and Twitter of the Wii Fit or smartphone-based fitness applications as the subjects for the current questionnaire survey that was performed between September and November 2020. For the current study, we used four concepts: presence, enjoyment, flow and intention of sustainable use. Then, we proposed the following five hypotheses: “Presence might have a significant positive effect on flow,” “Presence might have a significant positive effect on enjoyment,” “Enjoyment might have a significant positive effect on flow,” “Enjoyment might have a significant positive effect on intention of sustainable use” and “Flow might have a significant positive effect on intention of sustainable use.” The current questionnaire study includes a total of 301 subjects, who comprise 188 men (62.5%) and 113 women (37.5%). Moreover, the subjects are composed of 167 (55.5%) users of the Wii Fit and 134 users (44.5%) of smartphone-based fitness applications. We found that all the five hypotheses were accepted for users of the Wii Fit. We also found, however, that the following three hypotheses were accepted for users of smartphone-based fitness applications: “Presence might have a significant positive effect on flow.,” “Presence might have a significant positive effect on enjoyment.” and “Enjoyment might have a significant positive effect on intention of sustainable use.” Based on our results, it can be concluded not only that flow has a significant effect in mediating between presence, or enjoyment, and intention of sustainable use in users of the Wii Fit. Our results also indicate, however, that enjoyment has a significant effect in mediating between presence and intention of sustainable use in users of smartphone-based fitness applications.

Feasibility of a 3‐Dimensional Exergame to Promote Integrated Cognitive and Physical Activity in Aging Adults

AbstractBackgroundEvidence suggests that bi‐directional associations exist between cognition and mobility that magnify with increasing age. Both cognition and mobility are important to maintaining independent function in daily life. These and other findings suggest that cognition and mobility may share common neural substrates that can be trained simultaneously through real‐world simulations that safely promote navigation through complex virtual environments. However, few interventions explicitly train on cognition and mobility simultaneously. We optimized an immersive, 3‐Dimensional (3‐D) exergame to simultaneously train cognitive and motor functions in a community‐based setting for older adults.MethodWe recruited 16 older adults from an independent living community, with varying levels of physical function. Participants completed one‐hour sessions three times each week for five weeks for a total of 15 sessions. The customized game provides an immersive virtual oceanic environment in which the participants control a simulated dolphin (“Bandit”) that responds to the participant’s desired direction in 3‐D space and amid other oceanic fish, including sharks, orcas and small pods of fish. Participants used their dominant hand, tracked by motion sensors, to navigate this world to help “Bandit” eat fish, avoid being bitten by sharks, and jump out of the water. Players advanced in levels after mastering the preceding level. After completing all 110 game levels, participants switched to their non‐dominant hand to remaster all levels of the exergame again.Before and after the program, participants completed tests of memory, executive function, and speed of processing.ResultAll participants successfully completed the intervention, with the exception of one participant, with a vestibular disorder. In adjusted models (age, sex, education), post‐intervention improvement in processing speed was marginally significant (p = 0.06). No other cognitive improvements were found.ConclusionOur feasibility study demonstrated that we can effectively use this innovative exergame platform as a clinic‐ or community‐ based tool for individuals to safely practice and promote integrated skills related to complex, real‐world navigation.

3.24 Exergaming Using Obie® and its Effect in Improving Executive Function Deficits in Children With Fetal Alcohol Spectrum Disorder and Comorbid ADHD: An Exploratory Study

We conducted an exploratory study aimed to investigate if repeated exercise sessions (12 sessions; twice a week for 6 weeks) using the OBIE® Interactive Exergaming Platform would improve executive functions and aerobic fitness (VO2max) in children and adolescents with fetal alcohol spectrum disorders (FASD) and comorbid ADHD. Through this novel, innovative “gamified” exercise, it was hypothesized that the participants would demonstrate improvements in aerobic fitness and executive functions.

Digital Biomarkers for Well-being Through Exergame Interactions: Exploratory Study.

BackgroundEcologically valid evaluations of patient states or well-being by means of new technologies is a key issue in contemporary research in health and well-being of the aging population. The in-game metrics generated from the interaction of users with serious games (SG) can potentially be used to predict or characterize a user’s state of health and well-being. There is currently an increasing body of research that investigates the use of measures of interaction with games as digital biomarkers for health and well-being.ObjectiveThe aim of this paper is to predict well-being digital biomarkers from data collected during interactions with SG, using the values of standard clinical assessment tests as ground truth.MethodsThe data set was gathered during the interaction with patients with Parkinson disease with the webFitForAll exergame platform, an SG engine designed to promote physical activity among older adults, patients, and vulnerable populations. The collected data, referred to as in-game metrics, represent the body movements captured by a 3D sensor camera and translated into game analytics. Standard clinical tests gathered before and after the long-term interaction with exergames (preintervention test vs postintervention test) were used to provide user baselines.ResultsOur results showed that in-game metrics can effectively categorize participants into groups of different cognitive and physical states. Different in-game metrics have higher descriptive values for specific tests and can be used to predict the value range for these tests.ConclusionsOur results provide encouraging evidence for the value of in-game metrics as digital biomarkers and can boost the analysis of improving in-game metrics to obtain more detailed results.

An IoT-Enabled Platform for the Assessment of Physical and Mental Activities Utilizing Augmented Reality Exergaming.

Augmented reality (AR) and Internet of Things (IoT) are among the core technological elements of modern information systems and applications in which advanced features for user interactivity and monitoring are required. These technologies are continuously improving and are available nowadays in all popular programming environments and platforms, allowing for their wide adoption in many different business and research applications. In the fields of healthcare and assisted living, AR is extensively applied in the development of exergames, facilitating the implementation of innovative gamification techniques, while IoT can effectively support the users’ health monitoring aspects. In this work, we present a prototype platform for exergames that combines AR and IoT on commodity mobile devices for the development of serious games in the healthcare domain. The main objective of the solution was to promote the utilization of gamification techniques to boost the users’ physical activities and to assist the regular assessment of their health and cognitive statuses through challenges and quests in the virtual and real world. With the integration of sensors and wearable devices by design, the platform has the capability of real-time monitoring the users’ biosignals and activities during the game, collecting data for each session, which can be analyzed afterwards by healthcare professionals. The solution was validated in real world scenarios and the results were analyzed in order to further improve the performance and usability of the prototype.

Physical Training In-Game Metrics for Cognitive Assessment: Evidence from Extended Trials with the Fitforall Exergaming Platform

Conventional clinical cognitive assessment has its limitations, as evidenced by the environmental shortcomings of various neuropsychological tests conducted away from an older person’s everyday environment. Recent research activities have focused on transferring screening tests to computerized forms, as well as on developing short screening tests for screening large populations for cognitive impairment. The purpose of this study was to present an exergaming platform, which was widely trialed (116 participants) to collect in-game metrics (built-in game performance measures). The potential correlation between in-game metrics and cognition was investigated in-depth by scrutinizing different in-game metrics. The predictive value of high-resolution monitoring games was assessed by correlating it with classical neuropsychological tests; the area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was calculated to determine the sensitivity and specificity of the method for detecting mild cognitive impairment (MCI). Classification accuracy was calculated to be 73.53% when distinguishing between MCI and normal subjects, and 70.69% when subjects with mild dementia were also involved. The results revealed evidence that careful design of serious games, with respect to in-game metrics, could potentially contribute to the early and unobtrusive detection of cognitive decline.

Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study.

BackgroundOlder adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames.ObjectiveThis study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation.MethodsThis is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis.ResultsThe protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I–Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022.ConclusionsThe effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials.Trial RegistrationClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988International Registered Report Identifier (IRRID)DERR1-10.2196/24665

Facilitators and Challenges to Exergaming: Perspectives of Patients With Heart Failure.

Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure. In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure. Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34-69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis. The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants' barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement. Exergaming can increase individuals' physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants' preferences and capacities, participants' past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.

High-intensity exergaming for improved cardiorespiratory fitness: A randomised, controlled trial

ABSTRACT Exergaming has been proposed as a promising alternative to traditional endurance training since many experience exergaming as more enjoyable. Therefore, the aim of this trial was to determine the exergaming-induced effect on cardiorespiratory fitness. This parallel-group randomised controlled trial, investigated the effects of regular exergaming among healthy adults (aged ≥ 18 years) who were not endurance-trained. Participants allocated to the exergaming group (n = 13) used the Playpulse exergaming platform for a minimum of 45 min twice weekly for eight weeks, whereas the control group (n = 17) received no intervention. The primary outcome measure was the between-group difference in peak oxygen uptake (V̇O2peak) after the intervention. V̇O2peak increased significantly from baseline (43.9 [SD 7.0]) to after the intervention (45.3 [SD 8.2] mL kg−1 min−1) in the exergaming group, compared to the control group (42.4 [SD 7.0] to 42.0 [SD 5.7] mL·kg−1·min−1) with a between-group difference of 2.1 mL kg−1 min−1 (95% CI: 0.2–4.1; p = 0.04). The average score on the Feeling Scale reported during exergaming was 3.4 (95% CI 3.2–3.6), with 3 being “good” and 5 “very good” and was not related to the participants’ exergaming skills. There were no adverse events during this trial. Two weekly sessions using the Playpulse exergaming platform can improve V̇O2peak. This finding suggests that exergaming can be an efficient form of endurance training. Furthermore, our findings indicate that participants’ enjoyed exergaming irrespective of exergaming skills. Trial registration: ClinicalTrials.gov identifier: NCT04112329..

Can Gaming Get You Fit?

RationaleExergaming may be a viable alternative to more traditional exercise. As high-intensity exercise can provide substantial health benefits, the purpose of this study was to investigate the long-term effectiveness of providing inactive adults with access to a high-intensity exergaming platform.MethodsIn this study, 52 inactive adults (<150 min of exercise per week), aged 18 years or older, were randomized (1:1) into an exergaming (N = 27) or a control group (N = 25). Exergaming participants were given access to the Playpulse exergaming platform for 6 months, where they decided how frequently they wanted to use the platform. The primary outcome measure, analyzed with a mixed model, was peak oxygen uptake (V̇O2peak). Secondary outcomes included body composition, blood pressure, and blood markers of cardiometabolic health.ResultsMean V̇O2peak at 6 months was 42.3 (SD 7.0) mL⋅kg−1⋅min−1 and 41.9 (SD 7.4) mL⋅kg−1⋅min−1 for the exergaming and control group, respectively with no significant between-group differences (-0.7, 95% CI -2.7 to 1.3, P = 0.49). Apart from increased moderate-intensity physical activity in the exergaming group at 3 months (21.9 min⋅day−1, 95% CI: 2.2 to 41.5, P = 0.03) compared to the control group, there were no significant between-group differences for any outcome at either 3 or 6 months. On average, participants in the exergaming group performed 12 (SD 13) exergaming sessions with an average heart rate of 74.5 (SD 7.5)% of maximum heart rate, throughout the intervention.ConclusionDue to low exergaming frequency over the 6-month intervention, exergaming participants showed no significant health benefits compared to control. Our study indicates that although the Playpulse exergaming platform is found enjoyable, this is not enough to motivate inactive adults to regularly engage in exercise and thereby improve health.Clinical Trial Registrationwww.clinicaltrials.gov, identifier NCT03513380.

Cardiometabolic Effects Of Free Access To An Exergame In Inactive Adults: A Randomized Controlled Trial

Exergames are videogames that require physical movement or exertion from the user. Exergames have been suggested to be a motivating alternative to increase physical activity for adults not engaged in traditional exercise. However, limited high-quality data is supporting the long-term effectiveness of exergames for improving health outcomes. PURPOSE: To determine if providing sedentary adults access to a high-intensity exergame could improve cardiometabolic health. METHODS: This was a randomized controlled trial in which 52 inactive but otherwise healthy adults were randomly allocated to either an exergaming (EXG; n=25) or control (CON; n=27) group. Participants in EXG got free, unlimited access to the Playpulse exergaming platform for six months, whereas participants in CON continued with their normal daily routine. We measured maximum oxygen uptake (V̇O2max), blood glucose response to a 2-h oral glucose tolerance test, fasting blood variables (glucose, cholesterol, high-sensitivity C-reactive protein, triglycerides), body composition, blood pressure and physical activity levels before and after the intervention period. We also assessed exergaming frequency and enjoyment (according to the -5 to +5 Feeling Scale) in the EXG group. Data were analyzed using covariance analyses (ANCOVA) with baseline values as covariates or a two-way mixed ANOVA. RESULTS: There were no significant difference between CON and EXG for the primary outcome, post-intervention V̇O2max, after controlling for pre-intervention V̇O2max (42.34 ± 0.76 vs 41.71 ± 0.82 mL.min-1kg-1, p = 0.58). Even if not reaching statistical significance, there was a tendency of lower post-intervention low density lipoprotein cholesterol in EXG compared to CON (2.7 ± 0.7 vs 3.0 ± 0.7, p = 0.063). No other changes in secondary outcomes differed between groups. The participants in EXG played 15 ± 13 sessions (range, 0-42) during six months. Their rating of enjoyment was 3 ± 1 on the Feelings Scale. CONCLUSION: Our data show that free, unlimited access to an exergaming platform was not sufficient to improve V̇O2max, blood markers of cardiometabolic health, body composition, or increase physical activity levels in sedentary adults, even if the participants rated the exergame as enjoyable. Funded by The Norwegian Fund for Post-Graduate Training in Physiotherapy

Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study

BackgroundApolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before.ObjectiveThe effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated.MethodsUsing a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non–APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging.ResultsAll interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score—LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores—AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score—LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group.ConclusionsNone of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.

A study exploring the usability of an exergaming platform for senior fitness testing.

This study proposes a structural usability model to identify the relationship between the user interface design and the usability of an exergame system that includes a software system and a separate hardware device. The model consisted of two dimensions: the interface design, which was evaluated using Nielsen's heuristic evaluation method, and the usability, as defined by ISO 9241-11. An empirical study used the iFit exergame system to test the physical fitness of 101 seniors in order to evaluate the model's validity. The results showed a strong correlation between the interface design and the usability of the exergame system. An improved interface enabled users to interact with the system better, and the usability of the whole system was enhanced, including the device and the system itself. The results show that the proposed usability model can be used to evaluate other exergame systems.

Abstract P167: Exergaming Experience: Perspectives of Patients With Heart Failure

Background: Heart failure (HF) is a chronic illness that affects the physical and psychosocial well being of individuals afflicted with this debilitating disease. Physical activity in patients with HF is known to have positive outcomes. Exergaming is a new form of physical activity that has gained popularity among older adults and with older individuals with chronic illnesses. This home-based exercise platform has the potential to improve the physical activity in patients with HF. Aims: To explore HF patients perceived facilitators, attitudes and experiences when using an exergame platform at home utilizing the Nintendo Wii sports. This qualitative study was conducted as part of a larger study to determine feasibility and usability of using a home-based exercise program to improve the physical and psychosocial well-being in patients with HF. Methods: Semi-structured face to face interviews were conducted in 13 participants diagnosed with HF (5 women, age range between 35 and 67 years old). The participants were recruited at a university hospital HF clinic in Southern California. Participants were asked about their experience with exergames. Exergaming devices were installed in participants’ homes and they were given advice to use the devices a minimum of 30 minutes a day. The interviews evolved around themes such as acceptance of exergame, usefulness and engagement. Transcribed interviews were analyzed with content analysis. Results: The exergame device was easy to use. The virtual reality environment appeared real. However, participants verbalized challenges with hand-eye coordination in playing some of the games. Not all participants felt improvement in their physical activity. Participants reported eagerness and fun with exergaming but engagement diminished overtime. Greater variation of exergames were identified to reduce monotony. Conclusion: This study provided insight on the value of home-based exercise platform using technology in improving the physical activity of participants with HF. Participants’ perceptions of usefulness, acceptability and engagement are warranted to ensure that exergaming will achieve the intended aim of improving physical activity and ultimately improve the overall well being and health care delivery in this patient population.

Development of an EMG-based exergaming system for isometric muscle training and its effectiveness to enhance motivation, performance and muscle strength

Abstract Isometric exercises can be used for general strength conditioning or rehabilitation. To maximize their benefits without excess muscle fatigue, such exercises must be performed under medical prescription, which also needs to specify their intensity and duration. However, at home or at a clinic they are rarely real-time monitored or evaluated, which may delay or prevent goal achievement, with negative influence on participants’ motivation. Therefore, in this paper, it is introduced the development and clinical evaluation of an exergaming platform based on ElectroMyoGraphy (EMG) for the real-time monitoring and performance assessment of personalized isometric exercises. The system enables medical personnel to create personalized exergame sessions that oversee in real time the behavior of the main character in a game, based on the muscle force of the user, estimated from an EMG signal. In addition, it evaluates exercise performance, in terms of muscle contraction duration and relative effort during work and rest intervals. A data storage capability enables users to upload results in a cloud database, which can be accessed remotely by healthcare providers through an application. The system operates firstly by obtaining an EMG-force model for isometric contractions of the flexor digitorum superficialis muscle, which was then integrated in the exergaming platform. Then, a 4-week randomized controlled clinical trial was conducted with tailored isometric handgrip exercises using the proposed system versus conventional handgrip exercises to assess motivation and grip strength in patients with distal radius fracture. Exercise performance and subjective workload ratings were additionally evaluated. Results notably show that handgrip exercises with the proposed system yield an improvement in grip strength of 40.2% over conventional handgrip exercises, while experiencing higher motivation levels, contrasting with lower frustration and mental demand levels. However, continued research is ongoing to generalize the findings of the clinical trial to a larger patient population.

Exergaming Through the Eyes of Patients with Heart Failure: A Qualitative Content Analysis Study.

Exergaming appears to be a promising tool to increase exercise capacity in patients with chronic heart failure (HF). Therefore, it is important to obtain more in-depth knowledge about preferences, attitudes, use, and abilities in regard to exergaming. The aim of this study was to describe the experiences of patients with HF when using an exergame platform at home. A qualitative descriptive study using content analysis was conducted on interviews with 14 patients with HF (6 women, ages ranging between 56 and 81 years). The patients were recruited from three centers in Sweden included in a randomized controlled study. These patients had access to an exergame platform at home and were advised to exergame for 30 minutes per day. The analysis resulted in three categories describing patients' experience of exergaming: (1) making exergaming work, (2) added value of exergaming, and (3) low appeal of exergaming. This is the first study that explores how patients with HF experience using an exergame platform at home. The study provided important information on what aspects to discuss when initiating an exergame platform at home and following patients who may want to use an exergame platform at home. The results also revealed that this technology may be suitable for some patients, while others prefer other kinds of physical activity.

Moving Real Exergaming Engines on the Web: The webFitForAll Case Study in an Active and Healthy Ageing Living Lab Environment.

Exergames have been the subject of research and technology innovations for a number of years. Different devices and technologies have been utilized to train the body and the mind of senior people or different patient groups. In the past, we presented FitForAll, the protocol efficacy of which was proven through widely taken (controlled) pilots with more than 116 seniors for a period of two months. The current piece of work expands this and presents the first truly web exergaming platform, which is solely based on HTML5 and JavaScript without any browser plugin requirements. The adopted architecture (controller application communication framework) combines a unified solution for input devices such as MS Kinect and Wii Balance Βoard which may seamlessly be exploited through standard physical exercise protocols (American College of Sports Medicine guidelines) and accommodate high detail logging; this allows for proper pilot testing and usability evaluations in ecologically valid Living Lab environments. The latter type of setups is also used herein for evaluating the web application with more than a dozen of real elderly users following quantitative approaches.

Personalized Game Suite: A unified platform to sustain and improve the Quality of Life of Parkinson’s Disease patients

Personalized Game Suite: A unified platform to sustain and improve the Quality of Life of Parkinson’s Disease patients